This exploratory study will examine if there are unique pathways to suicide attempt using 13 waves of prospective longitudinal data on two ongoing epidemiologically sampled cohorts of 2953 young adults (300 with a prior suicide attempt) originally recruited upon entry to first grade in 28 inner city Public Schools in Baltimore, Maryland. This project will assess the influence of individual psychiatric, familial (parenting, family history), environmental (exposure to violence, sexual/physical abuse), social, and high risk behaviors (sexual, drug use) during the course of development on distinct pathways to suicide attempt. Research has shown that it is very difficult to predict suicide deaths and suicide attempt, perhaps because there are multiple pathways or subtypes. The identification of subtypes is highly significant because appropriate intervention approaches for subtypes may differ. It is also possible that the SA subtypes could represent more homogenous genetic groups yielding greater ability to detect genetic variation in vulnerability for SA. Studies have identified risk and protective factors but few have identified multiple factors prospectively through the course of development to identify processes or mechanisms. The majority of participants with SA in our community sample (~60%) have never met DSM-IV criteria for a major depressive episode. There is a growing literature on the importance of trait aggression/impulsivity as a strong indicator of suicide risk with a possible biological basis. It is unclear if there is a distinct subgroup defined by trait aggression with increased liability of SA. We will study multiple domains of childhood, adolescent and young adult experiences as reported by the participants, peers, parents, teachers, and public records (arrest records). The project will assess the effect of specific genetic markers of risk for suicide attempt (i.e., SLC6A4, TPH1, BDNF, FKBP5) overall and in subgroups, based upon the developmental pathways or trajectories identified. The results of this study will advance our current understanding of the processes and mechanisms associated with suicide attempts among ethnically diverse, urban community populations. PUBLIC HEALTH RELEVANCE: This R21 project entitled Developmental Pathways to Suicide Attempt aims to identify distinct pathways or trajectories to suicide attempt in 2953 young adults (300 suicide attempters) initially recruited upon entry to first grade in Baltimore City Public Schools. Improvement in the ability to predict suicide attempts through the identification of specific risk and protective factors experienced over the course of child and adolescent development is an important goal for the prevention of suicide.